As part of a mid-summer trip to Burkina Faso in West Africa, I devoted a day to population, reproductive health, and family planning issues -- the "P" in PRM. It turned out to be an informative and also very moving experience.
The day began with a conversation with Madame Chantal Compaoré, the President's wife. She is a prominent figure on a number of women's issues in Burkina Faso, but also has spoken out at high level meetings around the world, most recently at the July 11 London Family Planning Summit co-sponsored by the UK government and the Bill and Melinda Gates Foundation.
The meeting with the First Lady was supposed to be short, but turned into a real and lengthy discussion that also involved the Minister of Health Adama Traoré, the Minister of Social Affairs, Clemence Traoré Somé, and the Director of Family Health, Dr. Amedée Prosper Djiguemdé. Her list of concerns included expanding family planning programs, reducing maternal mortality and protecting women's reproductive rights. She is best known for her work calling for an end to the practice of female genital mutilation/cutting (FGM/C). Tradition dictates that a daughter's future as a bride can be secured through cutting. While progress is being made in convincing families to stop subjecting their daughters to this dangerous practice, some persist in doing it, going so far as to cross borders into neighboring countries in order to have the cutting done. The U.S. Government strongly agrees with local leaders here: FGM is a violation of the human rights of women and girls.
After the Presidential residence, we visited the Marie Stopes International (MSI) Clinic where reproductive health specialists showed me the tools they use to discuss the various family planning options. Simple methods such as condoms and cycle bead bracelets that help women keep track of when they are fertile are available but MSI also provides modern contraceptive methods such as implants, IUDs, and injectables. During our tour of the clinic we had the chance to speak with several clients. One woman expressed appreciation for the low cost services MSI offered -- she said she had her hands full with three young sons. Family planning allows her to choose the size of her family.
USAID is providing nearly $7 million from 2010-2013 for reproductive health and family planning activities in Burkina Faso. I had an opportunity to hear from many of USAID’s partners at a roundtable discussion hosted by the U.S. Embassy. These key stakeholders described the challenges they face in reducing the high rate of maternal mortality, combating FGM/C, and meeting the demand for family planning where one in three women has an unmet need. It was especially disheartening to learn that adolescent girls account for 30 percent of maternal deaths in Burkina Faso. We also learned more about the work of NGOs, foundations, and other governments to support the Government of Burkina Faso in meeting its recently announced, ambitious commitment to increase the use of voluntary modern family planning methods from the current 15 percent to 25 percent by 2015.
We ended the day with a visit to the Rama Foundation, a recovery center for women and girls who developed obstetric fistula after pregnancy. The problems that resulted from this condition -- incontinence, inability to control one's bowels, problems staying clean or taking part in village life -- had resulted in a sort of social death and ostracism. Several of the women we met were married and experienced their first pregnancy before the age of 15, before their bodies were fully able to physically manage pregnancy and childbirth.
The Rama Foundation helps women not only by arranging surgery and giving them a place to stay during the recovery period, but also teaching them a trade such as soap-making and weaving. The Foundation is supported by a number of organizations including the UN Population Fund (UNFPA). The U.S. is a top contributor to UNFPA, providing $35 million in core funding in 2012.
Most heart-breaking for me was hearing the stories of middle-aged women who had suffered from fistula for years and years before receiving help. Rejected by their husbands and families, they had heard about the Rama Foundation on the radio or been told by a brother or friend. Surgery can completely repair fistula in most cases, but some of the women I met had required a number of surgeries. UNFPA and the formidable Madame Rasmata Kabre, the founder of the Rama Foundation, deserve praise for helping these women rebuild their lives after they've been rejected and ignored by so many others.
Looking back on the day, I realize how early marriage, FGM/C, and limited access to health care can lead to other problems, including fistula or death in pregnancy or childbirth. In Ouagadougou I saw first-hand that the term “reproductive health” means much more than distributing condoms -- it is a critical development priority that preserves the health, well-being and lives of women and girls and helps families and communities prosper.
Anne C. Richard
Assistant Secretary for the Bureau of Population, Refugees, and Migration